I had one of those encounters a few days ago that left me angry and irritated. Angry because I can’t understand how a woman, in her mid- 40s and pregnant (first trimester), can walk around comfortably knowing her blood pressure is high, yet refuses treatment. Irritated, because she will be coming back in a week or so to check her blood pressure again, and it’s going to remain high and I will have the same conversation with her and she’ll refuse treatment. She intends to treat her blood pressure the “natural” way – acupuncture, massage therapy, herbal teas, naturopathy and Reiki.
Did I mention she has 4 other children at home?
Her blood pressure wasn’t just a little elevated, it was 150/100. Two years ago, her blood pressure was 140/80. She likely had some early essential hypertension then. Now, being pregnant, not only does she have untreated essential, chronic hypertension, she is also hugely at risk for developing preeclampsia. I explained this to her. I told her all the risks to her own health (seizure, stroke, death), as well as to the baby she is carrying (spontaneous abortion, intrauterine fetal growth restriction, intrauterine fetal demise, stillbirth). She still refused treatment.
I have several patients in my practice who want to have a family doctor but don’t actually prescribe to a lot of Western medicine. These patient will see their naturopath, osteopath, chiropractor and acupuncturist first. Sometimes they come to see me when those approaches aren’t working. Some patients accept that those approaches didn’t help and come to me seeking the “Western” approach, which more times that not, relieves their problem.
A lot of these patients actually “interview” me at their first visit and ask me how I feel about these approaches. My answer is generally pretty straight forward. I don’t really have a problem when patients seek the alternative/complementary approach. It is their money to spend. Sometimes a chiropractor can be quite helpful for mechanical back pain. I would know as I saw one in my 20s and it helped immensely. But sometimes these approaches don’t work. I saw an acupuncturist for my migraine headaches. Countless needles in my skull and a few hundred dollars later, and my headaches were unchanged. What worked were the triptan drugs, thank you very much.
When alternative medicine becomes an issue with me is when the patient with a blood pressure of 180/110, and now complaining of headaches, repeatedly comes to the office to check how the alternative approach is working (it isn’t), then refuses to take my advice on treatment. When confronted with this, the patient responds with, “Okay, I’ll go back to Dr. So-and-So ND, and change the herbs. Thank you.” Uh huh. My job is, according to the patient, apparently done. This is when it gets tricky. How many times can I see this patient with dangerously high blood pressure before he strokes out? My job is to make sure he doesn’t. Yet, after explaining the risks to him, he still refuses the anti-hypertensive medication that has proven to work. So, I have to ask him why he continues to return to my office for visits? Clearly we are at a stalemate. And this is when I go back to the rest of the answer to that question he asked me two years ago. “Remember the conversation we had when we first met?” I ask him. He looks at me, puzzled. After a moment, he understands. This is when I say, “It’s time to re-evaluate our doctor-patient relationship. I am afraid I can no longer, in good conscience, continue to be your physician if you repeatedly refuse treatment for your hypertension. You are at great risk of having a stroke. By continuing to be your physician when you refuse to treat your hypertension, I am violating my Hippocratic Oath.”
I fear this may be how my relationship with the pregnant woman will end. She will return to my office in a week or two to check her blood pressure. I expect it will continue to be elevated. And I suspect she will continue to refuse Western medical treatment. Not only is she risking her own life, now she is risking the life of her unborn child, not to mention risking the well-being of her four other children at home who need their mother.
How, in good conscience, can I continue to be her physician?